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ACU COURSE > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

When are pacemakers used?

A

To stimulate a patient’s heart when they are experiencing bradycardia and HR cannot be improved by drugs (ie - Atropine)

Most often used to treat symptomatic bradycardia

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2
Q

What are the two types of temporary pacemakers?

What is the difference?

When are they used?

A

Transcutaneous - emergency situations, short term, use pacer pads

Transvenous - pacer wires placed in RV (lose atrial kick), can be left in x1 week

Used for bradycardic arrhythmias (heart blocks)

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3
Q

What are the four types of permanent pacemakers?

A

Single - atrial or ventricular
Dual - atrial and ventricular
CRT - dilated cardiomyopathy
ICD - life-threatening arrhythmias (can pace and defibrillate as needed)

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4
Q

When is atrial pacing indicated?

A

SA node dysfunction, but normal AV conduction

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5
Q

When is ventricular pacing indicated?

A

Damaged ventricular response

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6
Q

What is CRT used for?

A

Dilated cardiomyopathy - improve CO

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7
Q

When is epicardial pacing used?

A

Major cardio/thoracic surgeries in case of post-op arrhythmias

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8
Q

Demand pacing

Non-demand pacing

Rate responsive pacing

A

Fires only when needed (HR falls below predetermined rate)

Fires at a predetermined rate whether it is needed or not

Will speed up or slow down depending on the patient’s level of activity

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9
Q

Fire

Capture

Sense

A

Pacemaker sent an impulse

Impulse resulted in contraction

Pacemaker can detect pt’s own beats
- High # = higher fence = low sensitivity (wont’s sense pt’s electrical activity)
- Low # = lower fence = high sensitivity (will sense too much of pt’s electrical activity

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10
Q

Under-sensing

A

Sensitivity set too low (high fence)

Cannot sense patient’s own electrical activity

Can cause lethal rhythms (R on T phenomenon)

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11
Q

Over-sensing

A

Sensitivity set too high (low fence)

Senses too much of the patient’s own electrical activity

Ie - may sense pt movement and not fire sensing it as cardiac activity

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12
Q

What to do if a permanent PM fails to fire?

A

Call MD STAT
Call for PM Magnet
Prep for TCP
Call EP team to assess PM fx

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13
Q

Loss of capture

A

Pacer spikes do not result in complex - not enough energy to cause depolarization

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14
Q

CAD: Progressive ___________ disorder of the coronary arteries that result in ________ or complete ________

A

CAD: Progressive ATHEROSCLEROTIC disorder of the coronary arteries that result in NARROWING or complete OCCULUSION

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15
Q

Atherosclerosis: ______ builds up in arteries, blocking blood flow. Caused by accumulation of _____, _____, and waste products. Mature ______ can crack/rupture resulting in ________ ________

A

Atherosclerosis: PLAQUE builds up in arteries, blocking blood flow. Caused by accumulation of CHOLESTEROL, FATS, and waste products. Mature PLAQUE can crack/rupture resulting in CLOT FORMATION

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16
Q

ACS is the _______ of atherosclerosis

It includes:

A

ACS is the MANIFESTATION of atherosclerosis

It includes: stable angina, unstable angina, NSTEMI, STEMI

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17
Q

Angina

A

Lack of oxygen to heart muscle which leads to chest pain, discomfort, and pressure

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18
Q

Typical Chest Pain

A

Heavy chest pressure and/or pain/heaviness
Radiates to neck, jaw, shoulder, arms, back
SOB
Nausea
Sweating
Light-headedness

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19
Q

Atypical Chest Pain

Who does it often affect?

A

Pleuritic pain
Abdominal pain
Radiates to lower ext

Often affects women, elderly, diabetic individuals

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20
Q

Stable Angina: ________ and ______ by similar precipitating factors

Typically _______ induced and lasts less than ___ mins and relieved by _____

Is it detected by ECG/cardiac biomarkers?

Treatment: AABCO

A

Stable Angina: PREDICTABLE and REPRODUCIBLE by similar precipitating factors

Typically EXERTION induced and lasts less than 5 mins and relieved by REST

Is it detected by ECG/cardiac biomarkers? - NO

Treatment: AABCO
- Aspirin
- ACE inhibitor
- BB
- Clopidogrel
- Oral nitrates

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21
Q

Unstable Angina: ______ chest pain that occurs at ____ and gets worse

Not relieved by _______ or ________

A

Unstable Angina: UNPREDICTABLE chest pain that occurs at REST and gets worse

Not relieved by medication or rest

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22
Q

All new CP or change in frequency is considered _______ and should be treated as a potential MI until more information is gathered

A

All new CP or change in frequency is considered UNSTABLE and should be treated as a potential MI until more information is gathered

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23
Q

Irreversible myocardial necrosis that results from abrupt decrease or total blockage of blood flow to cardiac tissue

Two types

A

MI

NSTEMI
STEMI

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24
Q

NSTEMI: ______ occlusion of CA

May or may not be ________

May see _______ ________ on ECG

Confirmed by _________ __________

A

NSTEMI: PARTIAL occlusion of CA

May or may not be SYMPTOMATIC

May see ST DEPRESSION on ECG

Confirmed by CARDIAC BIOMARKERS

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25
Unstable Angina vs NSTEMI Treatment is the ________ Goal is to ______ ________ Difference is the presence of ______ ________ NSTEMI has ischemia severe enough to cause ______ ________ which causes the release of ________ ________
Unstable Angina vs NSTEMI Treatment is the SAME Goal is to PREVENT PROGRESSION Difference is the presence of CARDIAC BIOMARKERS NSTEMI has ischemia severe enough to cause MYOCARDIAL INJURY which causes the release of CARDIAC BIOMARKERS
26
TROP VS CK ________ is more sensitive and specific to myocardial damage Measured at _______ and q ______hrs until levels have peaked If a patient has a 2nd episode of CP, it is easier to recognize with _____ as they come back to baseline quicker _______ only stays elevated for 1-2 _____ wherease _____ stays elevated for 1-2 ____
TROP VS CK TROP is more sensitive and specific to myocardial damage Measured at PRESENTATION and q 3-6 until levels have peaked If a patient has a 2nd episode of CP, it is easier to recognize with CK as they come back to baseline quicker CK only stays elevated for 1-2 DAYS whereas TROP stays elevated for 1-2 WEEKS
27
Treatment for Unstable Angina/NSTEMI Nitro: ____mg SL/spray - ___ doses max in ___ mins __ mins apart Ask if they have taken ________ Contraindicated in patient with _________ MI Morphine: When pain not relieved after ______ O2: For sats <_____ or ________ ASA: Given on ______ and continued; ______mg _____ BB: Reduced myocardial _____ CCB: Decreases ______, _______, and HR Only for patients who do not respond to _____
Treatment for Unstable Angina/NSTEMI Nitro: 0.4 SL/spray - 3 doses max in 15 mins 5 mins apart Ask if they have taken VIAGRA Contraindicated in patient with VENTRICULAR MI Morphine: When pain not relieved after NITRO O2: For sats <90 or RESP DISTRESS ASA: Given on PRESENTATION and continued; 80-160 CHEWED BB: Reduced myocardial CONTRACTILITY CCB: Decreases AFTERLOAD, CONTRACTILITY, and HR Only for patients who do not respond to BB
28
STEMI: Thrombus _________ occludes CA If quickly identified and treated, myocardial injury can be _______ Main treatment goal is to ________ _________ via _____ or _______
STEMI: Thrombus COMPLETELY occludes CA If quickly identified and treated, myocardial injury can be REVERSED Main treatment goal is to RESTORE FLOW via PCI or FIBRINOLYTICS
29
PCI: Angioplasty and Stenting Target time ________ minutes after symptoms
PCI: Angioplasty and Stenting Target time < 90 minutes after symptoms
30
Fibrinolytic: Considered when _____ is not an option Coming from another hospital without cath lab and treatment exceeds _______ minutes ______ is most common. Contraindicated with ________ and _________
Fibrinolytic: Considered when PCI is not an option Coming from another hospital without cath lab and treatment exceeds > 120 minutes TNK is most common. Contraindicated with UNSTABLE ANGINA and NSTEMI
31
Fibrinolytic contraindications
Intracerebral hemorrhage Known aneurysm Uncontrolled HTN Oral anti-coagulants Recent surgery/internal bleeding **anything that might cause bleeding**
32
What drug should be avoided for STEMI?
NSAIDs and COX-2
33
Patients who have survived a cardiac arrest and are comatose, should be assessed for _________, post PCI intervention It can improve ______ outcome and survival post arrest
Patients who have survived a cardiac arrest and are comatose, should be assessed for TARGET TEMPERATURE MANAGEMENT, post PCI intervention It can improve NEURO outcome and survival post-arrest
34
PCI: Use to _____ and ______ partially or completely occluded coronary vessels A _____ inserted and mobilized to the identified blockage in the CA Once at the blockage site, ________ and ________ can occur Major complication of angioplasty: immediate _________ of vessel, but done with ________ to prevent this
PCI: Use to TREAT and EVALUATE partially or completely occluded coronary vessels A CATHETER inserted and mobilized to the identified blockage in the CA Once at the blockage site, ANGIOPLASTY and STENTING can occur Major complication of angioplasty: immediate RE-STENOSIS of vessel, but done with STENTING to prevent this
35
Two Types of Stents: Bare Metal Stent: Fewer _______ complications, but a higher incidence of _______ and rapid growth and spread of _______ Drug Eluting Stent: Have medication to inhibit ________ _________, decreased risk of ________, but increased risk of ______
Two Types of Stents: Bare Metal Stent: Fewer THROMBOSIS complications, but a higher incidence of RE-STENOSIS and rapid growth and spread of CELLS Drug Eluting Stent: Have medication to inhibit CELLULAR PROLIFERATION, decreased risk of RE-STENOSIS, but increased risk of THROMBOSIS
36
PCI: Radial vs Femoral Approach Which one is the standard? Why (x2) Which one is used for extensive PAD?
PCI: Radial vs Femoral Approach Radial - less bleeding, fewer activity limitations Femoral
37
PCI Nursing Management: Monitor ____ Close ______ monitoring for reperfusion ______ Monitor _______ enzymes Assess ______
PCI Nursing Management: Monitor VS Close TELEMETRY monitoring for reperfusion ARRHYTHMIAS Monitor CARDIAC enzymes Assess SITES, PERIPHERAL PULSES
38
Coronary Artery Bypass Grafting Surgical procedure where ___________ from another area of the body are _______ and used to create a ____ route for the hearts blood supply Used when patients have ____ or more ______ arteries and severe left CAD ____________ procedure
Coronary Artery Bypass Grafting Surgical procedure where BLOOD VESSELS from another area of the body are REMOVED and used to create a NEW route for the hearts blood supply Used when patients have 3 or more STENOTIC arteries and severe left CAD EMERGENT RESCUE procedure
39
CABG Post-Op Nursing Management: Assess ______ _______ pacing wires in-situ Monitor ______ sites
CABG Post-Op Nursing Management: Assess VS EPICARDIAL pacing wires in-situ Monitor GRAFT sites
40
What is heart failure?
An issue with the heart muscle - not pumping effectively Impairs the ability of the ventricle to fill/eject blood
41
LS Heart Failure: Systolic Dysfunction The inability of the ventricle to _______ properly - not ______ normally Reduced _______
LS Heart Failure: Systolic Dysfunction The inability of the ventricle to EMPTY properly - not CONTRACTING normally Reduced EF
42
LS Heart Failure: Diastolic Dysfunction The inability of the ventricle to ______ properly - not _______ normally Increased _______
LS Heart Failure: Diastolic Dysfunction The inability of the ventricle to FILL properly - not RELAXING normally Increased EF
43
What type of symptoms do you have with LSHF?
Respiratory congestion - heart backing up into the lungs SOB, orthopnea, crackles/wheezes, pink/frothy sputum, CP, confusion, S3/S4 sounds
44
Which side of the stethoscope is used to listen to heart and lung sounds?
Diaphragm
45
Where is the aortic sound heard?
R2ICS - sternal border
46
Where is the pulmonic sound heard?
L2ICS - sternal border
47
Where is the tricuspid sound heard?
L5ICS - sternal border
48
Where is the bicuspid sound heart?
L5ICS - mid-clavicular
49
Where is S1 heard?
Apex
50
Where is S2 heard?
Base
51
Which heart sounds best heard with bell?
S3/S4
52
S3
Ventricular gallop An excessive amount of blood enters ventricle quickly - dilated LV (overly-compliant) - systolic
53
S4
Atrial gallop Atria contract against stiff ventricle (non-compliant) - diastolic
54
Left ventricle HF can lead to which arrhythmia?
Atrial fibrillation
55
What is an LVAD?
A left ventricular assist device (LVAD) is implanted in the chest. It helps pump blood from the lower left heart chamber (left ventricle) to the rest of the body
56
What is an RVAD?
An external right ventricular assist device (RVAD) helps support the right ventricle's function and pump blood to the lungs
57
In patient's with an LVAD/RVAD, patient's do not have a ________ or ______
In patient's with an LVAD/RVAD, patient's do not have a PULSE or BP
58
How to check if LVAD/RVAD is working?
A stethoscope should be placed over the apex of the heart to listen for a humming sound Absence of a humming sound indicates that the LVAD is not working
59
RS HF Manifestations
Weight gain Edema JVD Ascites Hepatomegaly
60
RSHF Causes
LSHF Pulmonic Valve Stenosis
61
Last resort treatment for heart failure?
Heart transplant
62
Cardiomyopathy: _______ and/or _______ dysfunction resulting in ventricular ______ or _________
Cardiomyopathy: ELECTRICAL and/or MECHANICAL dysfunction resulting in ventricular DILATION or HYPERTROPHY
63
Cardiomyopathies: Dilated Hypertrophy Restrictive
Cardiomyopathies: Dilated - ventricular enlargement with thinning of the ventricular wall Hypertrophy - thickening of the muscle wall Restrictive - infiltration/fibrosis
64
Preload and Afterload: Preload is the initial _______ of the cardiac myocytes (muscle cells) prior to contraction. It is related to ventricular ________. Afterload is the force or load against which the heart has to _______ to eject the blood.
Preload is the initial STRETCHING of the cardiac myocytes (muscle cells) prior to contraction. It is related to ventricular FILLING. Afterload is the force or load against which the heart has to CONTRACT to eject the blood.
65
Grading Valvular Disease: Stages A-D Stage D is when ________ develop
Grading Valvular Disease: Stages A-D Stage D is when SYMPTOMS develop
66
Aortic Stenosis: _______ of the aortic valve Causes increased ______ resulting in left ventricular ___________ Will hear a systolic ________ Diagnosed using an ___________ Presence of ________ determines if stenosis is ________ or not Medical management does not alter ___________, and is only used for ___________ _______
Aortic Stenosis: NARROWING of the aortic valve Causes increased AFTERLOAD resulting in left ventricular HYPERTROPHY Will hear a systolic MURMUR Diagnosed using an ECHO Presence of SYMPTOMS determines if stenosis is SEVERE or not Medical management does not alter PROGRESSION, and is only used for SYMPTOM RELIEF
67
Which medication should be avoided in patients with aortic stenosis? Which medications should be administered?
Beta-blockers - can worsen Rate control (digoxin, amiodarone) Diuretics ACE inhibitors
68
Aortic Stenosis: Valve Replacement (SAVR vs TAVR) Surgical Mechanical Valves: More _____, but require lifetime ________ Surgical Tissue Valves: Less ________, but no _________ required SAVR requires open heart surgery and is not optimal for _____ _______ patients TAVR: No open heart surgery, higher risk of _____, but more optimal for high-risk patients
Aortic Stenosis: Valve Replacement (SAVR vs TAVR) Surgical Mechanical Valves: More DURABLE, but require lifetime ANTICOAGULATION Surgical Tissue Valves: Less DURABLE, but no ANTICOAGULATION required SAVR requires open heart surgery and is not optimal for HIGH-RISK patients TAVR: No open heart surgery, higher risk of STROKE, but more optimal for high-risk patients
69
Aortic Regurgitation is when aortic valve does not ______ ________ and blood flows back into the _____ LV has to deal with normal amount of blood + extra blood that did not exit the heart = increased _______ = ventricle will ________ and ________ and overtime go into LV ___________ ________ murmur Treatment: CCB, BB, AVR
Aortic Regurgitation is when aortic valve does not CLOSE TIGHTLY and blood flows back into the LV LV has to deal with normal amount of blood + extra blood that did not exit the heart = increased WORKLOAD = ventricle will HYPERTROPHY and DILATE and overtime go into LV HEART FAILURE DIASTOLIC murmur Treatment: CCB, BB, AVR
70
MITRAL STENOSIS: Recurrent damage to the mitral valve causes blood flow across the MV to the ____ to be _____ This increases pressure in the ______ causing blood to back up into the _______ circulation Chronic congestion will lead to ______ dilation which may lead to _______ __________ _________ murmur Treatment: ______ control, _________ for a-fib, diuretics, and avoid strenuous activity 1) Percutaneous mitral balloon valvotomy 2) Commissurotomy 3) Mitral Valve Replacement
MITRAL STENOSIS: Recurrent damage to the mitral valve causes blood flow across the MV to the LV to be REDUCED This increases pressure in the ATRIA causing blood to back up into the PULMONARY circulation Chronic congestion will lead to ATRIAL dilation which may lead to ATRIAL FIBRILLATION DIASTOLIC murmur Treatment: HR control, ANTICOAGULANTS for a-fib, diuretics, and avoid strenuous activity 1) Percutaneous mitral balloon valvotomy 2) Commissurotomy 3) Mitral Valve Replacement
71
Left Atrial Appendage: Out-pouching of ____ that allows atria to dilate and become _____ if necessary Blood can ____ in this area Surgeons may do __________ to remove it and reduce the risk of stroke during mitral valve replacement
Left Atrial Appendage: Out-pouching of LA that allows atria to dilate and become LARGER if necessary Blood can CLOT in this area Surgeons may do LIGATION to remove it and reduce risk of stroke during mitral valve replacement
72
Mitral Regurgitation: The mitral valve does not close properly and blood backflows into ____ Overtime, LA ______ and ________ ________ murmur Treatment: Treat the _____ - stage ___ is the only stage where MVR is recommended
Mitral Regurgitation: The mitral valve does not close properly and blood backflows into LA Overtime, LA STRETCH and DILATE SYSTOLIC murmur Treatment: Treat the CAUSE - stage D is the only stage where MVR is recommended
73
PERICARDITIS: Pericardium is a sac containing the heart and roots of great vessels Pericarditis is _____ of this sac and causes ++ ______ _________ By definition, anyone who receives ________ _________ _______ will have pericarditis Most common causes: recent ___ or _______ failure 2* to uremic accumulation
PERICARDITIS: Pericardium is a sac containing the heart and roots of great vessels Pericarditis is INFLAMMATION of this sac and causes ++ CHEST PAIN By definition, anyone who receives OPEN HEART SURGERY will have pericarditis Most common causes: recent MI or RENAL failure 2* to uremic accumulation
74
Pericarditis Assessment: Chief complaint: ______ _____ Pain is _____, sharp and positional Increases with _______ breath Lying on _____ or ____ will also increase pain Patient may also be ______ and have shallowing breathing and patients are prone to _______-arrhythmias Pericardial friction rub is present when patient is lying on ______ side. Have patient take a deep breath and hold. If still hear the rub, it is ______. If it goes away, it is ________.
Pericarditis Assessment: Chief complaint: CHEST PAIN Pain is PLEURITIC, sharp and positional Increases with DEEP breath Lying on BACK or LEFT SIDE will also increase pain Patient may also be TACHYPNEIC and have shallowing breathing and patients are prone to TACHY-arrhythmias Pericardial friction rub is present when patient is lying on LEFT side. Have patient take a deep breath and hold. If still hear the rub, it is PERICARDIAL. If it goes away, it is PLEURAL.
75
What medication to use with caution with pericarditis?
Anticoagulants - may cause more bleeding which may lead to cardiac tamponade (pericardium is inflamed and raw)
76
MYOCARDITIS: Inflammation of the __________ Most often caused by ________ infection Usually, resolves ________ _______ _______, but limit _____ to decrease damage as well as reduce ______ intake to decrease fluid retention
MYOCARDITIS: Inflammation of the MYOCARDIUM Most often caused by VIRAL infection Usually, resolves ON ITS OWN, but limit ACTIVITY to decrease damage as well as reduce SALT intake to decrease fluid retention
77
ENDOCARDITIS: Inflammation of the ______ (______ of the heart), usually on the heart ______ - which often leads to ______ vegetation. These can break free and ______ to distal organs. Infective endocarditis is usually caused by _____ in the _____ or _____ procedures. A ______ can be used to diagnose. Patients may present with: - Hematuria 2* _______________ - Osler nodes - Janeway lesions - Splinter hemorrhages
ENDOCARDITIS: Inflammation of the ENDOCARDIUM (LINING of the heart), usually on the heart VALVES - which often leads to VALVE vegetation. These can break free and EMBOLIZE to distal organs. Infective endocarditis is usually caused by BACTERIA in the BLOOD or DENTAL procedures. A TTE can be used to diagnose. Patients may present with: - Hematuria 2* GLOMERULARNEPHRITIS - Osler nodes - Janeway lesions - Splinter hemorrhages
78
MAP Calculation: SBP + (2DBP) / 3 Normal: _____ to _____ mmHg Tells us how well organs are being ________
MAP Calculation: SBP + (2DBP) / 3 Normal: 70 to 100 mmHg Tells us how well the body is being PERFUSED
79
How might a ventricular-paced rhythm affect CO?
No atrial kick = decreased CO

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